Texas Medicare Insurance

Who is Eligible for Medicare?

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Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

You can get Part A of Medicare at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad benefits but haven’t yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Medicare Part A without having to pay premiums if you have:

• Received Social Security or Railroad Retirement Board disability benefits for 24 months.
• End-Stage Renal Disease and meet certain requirements.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. The Part B monthly premium in 2008 is $96.40 It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get the above payments, Medicare sends you a bill for your Part B premium every 3 months.

What Medicare Covers:

• Medicare Part A (Hospital Insurance), which helps pay for care in a hospital and skilled nursing facility, home health care, and hospice care.
• Medicare Part B (Medical insurance), which helps pay for doctors, outpatient hospital care, and other medical services.

General Enrollment period for Medicare

If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period. This period runs from January 1 through March 31 of each year. During this time you can sign up at your local Social Security office. It is important to note that the cost of Medicare Part B will go up 10% for each full 12 month period that you could have had Medicare Part B but didn’t take it. You will have to pay this penalty as long as you have Medicare Part B.

How Medicare Plans Work

Original Medicare
The Original Medicare Plan is a fee-for-service plan managed by the Federal Government In general, with the Original Medicare Plan.

• You use your red, white, and blue Medicare card when you get health care.
• You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
• You pay a set amount for your health care (a deductible) before Medicare pays its part. Then, Medicare pays its share, and you pay your share (your coinsurance or copayment) for covered services and supplies (unless you have a Medigap policy or other supplemental insurance that may pay for these costs.)
• You may have a Medigap policy or other supplemental coverage that pays deductibles, coinsurance, or other cost that aren’t covered by the Original Medicare Plan.

Medicare Coverage

Medicare covers certain medical services and supplies in hospitals, doctors’ offices, and other health care settings.  Services are either covered under Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance).  If you have both Part A and Part B, these services and supplies must be covered as long as they are reasonable and necessary for your health, no matter what type of Medicare plan you have.

Part A

1. Inpatient care in hospitals.  This includes critical access hospitals and inpatient rehabilitation facilities.
2. Inpatient stays in a  Skilled nursing facility (not custodial or long-term care).
3. Hospice care services
4. Home health care services
5. Inpatient care in a  Religious Non-medical Health Care Institution.

You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.  The 2008 Part A premium amount for people who have  to buy Part A is $423 each month. 

Part B

1. Helps cover medically-necessary services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover
2. Part B also covers some preventive services.

Medicare Health Plans include:

• Health Maintenance Organization (HMO),
• Preferred Provider Organization (PPO),
• Private Fee-for-Service (PFFS) Plans,
• Medicare Medical Savings Account (MSA) Plans,
• Medicare Special needs Plans

Other Medicare Health Plans

There are some types of Medicare Health Plans that aren’t part of Medicare Advantage, but are still part of the Medicare Program. With these plans, you generally get all your Medicare-covered health care through that plan. Some plans cover prescription drugs.

Other Medicare Health Plans include:

• Medicare Cost Plans,
• Demonstration/Pilot Programs,
• PACE (Programs of All-inclusive Care for the Elderly).

Medicare Prescription Drug Plans

Medicare Prescription Drug Plans are offered by insurance companies and other private companies approved by Medicare. They add coverage to:

• The Original Medicare Plan,
• Some Medicare Cost Plans,
• Some Medicare Private Fee-for-Service Plans, and
• Medicare Medical Savings Plans.

With a Medicare Prescription Drug Plan:

• Generally, you pay less for your prescriptions.
• You will get a plan member card after you enroll. You use this casrd when you go to the pharmacy to get your prescriptions filled.
• You will pay the copayment, coinsurance, and/or deductible, if any.
  

If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs.

To find out how we can help you reduce the cost of your Texas Medicare supplement insurance premium, please use the free quote form on the right, or call 281-238-6038 now.